On-demand primary care doctors only served Michigan’s wealthy. Not anymore.

“I only regret not signing up sooner” for this kind of care, said Boudrie, 45 of Warren after leaving with a bandage and no bill.

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Once thought limited to only wealthy patients, this form of on-demand medical care — no-wait appointments, a doctor’s cell phone number, even house calls when needed — is becoming more affordable to  everyday Michiganders.

For some people, it may be more affordable than traditional medical care with insurance.

“It’s concierge medicine for blue-collar” patients, said Dr. Adriana Raus, a direct care primary physician based in Okemos, east of Lansing. “It’s a fee that’s affordable for everybody — less than a cell phone bill.”

Orlich and Raus are among a growing number of family physicians stepping away from large practices, breaking ties with employer hospitals and thumbing their nose at insurers to provide a new kind of “direct primary care.” 

Under the model, patients pay a monthly fee — usually less than $100 — for unlimited access to primary care services: routine physicals, behavioral health support, and management of complex, multiple chronic conditions. 

By refusing insurance, direct primary care doctors say they can strip out the cumbersome insurance-related paperwork and extra staff and time that stand between them and patients. 

Moreover, they say, they can buy many of the most commonly used medications at pennies a pill sometimes, passing the savings along to patients with no mark-up to cover administrative insurance and pharmacy costs.

For $75 a month, Boudrie said she receives free, or nearly-free primary care. It includes regular check-ups, helps Boudrie manage stress and muscle pain, and offers rapid appointments for minor emergencies.

She also gets 24-hour access to Dr. Orlich’s cell phone.

“She always responds,” Boudrie said.

And Boudrie’s medications, including an antidepressant and a muscle relaxer, are less than $10 for a three-month supply.

As a part-time usher at Little Ceasar’s Arena, the Warren woman said she makes less than $15,000 a year and doesn’t carry insurance. Nor has she tried to get Medicaid.

For now, Dr. Orlich provides everything she needs, she said.

“You don’t feel like you’re being ripped off when you leave here,” she said.

Inside Plum Health last month, founder Dr. Paul Thomas began pulling meds off the shelf recently, rattling off the cost of each.

He rolled a large, white bottle of metformin, a common drug to help patients control Type 2 diabetes, in his hands. Even with insurance, a month’s supply is usually a $10 copay at the pharmacy, he said.

But by buying 1,000 tablets wholesale at about a penny a piece, he can offer them to patients — no mark-up — for roughly “90 cents for a three-month supply.”

He slipped the metformin back into the shelf, grabbing a smaller bottle to replace it.

“My last patient has high blood pressure and diabetes. We set him up with lisinopril,” he said, noting that the pills are less than one cent per pill. “When we give him 90 tabs, it’s 80 cents.”

“If we wanted to, we could have a 20 or 30 or 50 or 100 percent markup on meds, and they still would be really inexpensive,” Thomas said. “But we don’t. We only make money on the memberships.”

Direct primary care offices also contract with lab and imaging centers, again bypassing insurance and saving patients 50 to 90 percent on meds, labs, and imaging services, Thomas told Bridge.

Comprehensive blood work can cost hundreds of dollars through “big box” medical providers, Thomas told doctors Friday at a Michigan Academy of Family Physicians conference on Mackinac Island.

“About $30 gets (patients their) annual lab work” at Plum Health, he told the doctors.

Dr. Srikar Reddy, chair of the Michigan Academy of Family Physicians, said the direct primary care model gives doctors more autonomy by allowing them to control their patient loads.

But he said he worried some patients who can otherwise afford insurance will use direct primary care as a replacement for health coverage — which even doctors practicing this new model warn against. More serious emergencies are impossible to predict, Reddy said, making some form of health insurance critical. 

Direct primary care raises plenty of questions. 

No mark-up on prescription medicine?  

No administrative fees? 

No copays? 

And doctors on-call 24 hours?

Thomas said he is used to the inquiries. 

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